Focus: Mental Difference

This month eRenlai is focusing on the stigma surrounding mental health and mental disorders. For this purpose we’ve coined the term “mental difference” in the hope that this will encourage our readers to view the people around them not in terms of the binaries sick/well abnormal/normal insane/sane, but rather to approach everyone in the world with an open mind as to the way their mind functions and their personality traits, regardless of their mental health issues or lack thereof, or their deviation from our perception of the normal.

This month, eRenlai is focusing on the stigma surrounding mental health and mental disorders. For this purpose we've coined the term "mental difference" in the hope that this will encourage our readers to view the people around them not in terms of the binaries sick/well abnormal/normal insane/sane, but rather to approach everyone in the world with an open mind as to the way their mind functions and their personality traits, regardless of their mental health issues or lack thereof, or their deviation from our perception of the normal.

First we have two views from psychiatrists: the first gives us his view on what is normal, with an interview with Dr Wu Yuquan, the second is an interview concerning the effects of illegal and legal highs on the mind and body. Then Daniel reviews Anita and Shower, the two films cast mental disability in a more positive light. Paul Farrelly also has a film review for us, which deals with Reunion, a film about a teacher who quits to look after mentally disabled children and encounters resistance from the community, featuring two Taiwanese actors who later transitioned into careers in the spiritual world. Finally we have a short interview with Father Giuseppe Didone, he talks about his experience in Taiwan struggling to convince parents to overcome the stigma attached to mentally disabled children and get help for children in dire need of it, he also reflects on a shift in attitude from when he founded the school in the 1980s to the present day.

Perhaps, everyone has a crazy side; it’s just the extent to which it manifests that is different. If this is the case, how can we then draw a clear line between normal and abnormal?

When compared to other diseases that can be diagnosed in a clear-cut way, mental illness has always been an unsolved riddle. What makes people sink into insanity? Is this insanity a disease? These are problems that psychiatry is constantly faced with. Psychiatry has been a specialized subject for less than a hundred years; however, in the space of this short history, it has already experienced several paradigm shifts. Obviously these questions are always under scrutiny, and there have been no definite answers thus far.

Examining “insanity” throughout different paradigm shifts

Since ancient times, humankind has tried to explain “insanity” from every possible angle. In excavations of Mesopotamian Civilization remains, human skull bones that had been bored into have been unearthed, which reflects the belief of this ancient people that madness was a consequence of evil spirits entering the body. Because of this, it was necessary to bore a hole into the persons head to allow the evil spirits to escape. This kind of religious explanation has never quite completely disappeared. A few years ago the Catholic Church reinstated the practice of exorcism for believers with mental disorders.

However, following the rising popularity of the “rationalization” movement, and the Ancient Greek explanation of Humoral medicine, people began to believe that madness was brought about by an imbalance in bodily fluids. At the end of the sixteenth century, with the rise of dissections and anatomical medicine, the Humoral medicine model was superseded, and “insanity” began to be attributed to problems with the nervous system, and attempts were made to find lesions through dissection; but in the end it was not possible to determine a clear cause in this way, so mental illness began to be described as a problem with the “functionality” of the nervous system. After that there was the theory about the degeneration of the nervous system which was in vogue in the latter half of the nineteenth century and the first half of the twentieth century. This theory believed that this kind of degeneration was hereditary and could be passed on from generation to generation.

In addition, psychoanalysis and other such theories have attempted to explain mental illness from the point of view of psychology (which was once the main theory of psychiatry), particularly in this age where biological medicine is still unable to propose theories and treatments capable of convincing people. In the last few decades, psychological medicine has been slowly declining whereas biological psychiatry (which investigates mental illness from an organic approach, and believes that the cause for the disease is biological, for example an imbalance in brain neurotransmitters, brain lesions, or a change in the balance of the chemicals found within the body) is gradually increasing in popularity.

It can be said that humankind’s search for the cause of mental illness has never really ceased. Of course, the transformations aren’t necessarily dramatic, but rather have been developing consistently over time; the power of rationalization has always existed.

The blurry line between normal and abnormal

As the main school of thought in psychiatry today, biological psychiatry reflects the fate of psychiatry as a whole. Since the nineteenth century, it has wanted to become a genuine scientific discipline, yet it is still unable to reach its goal. Psychiatry can never treat sickness by just putting out a clear-cut diagnosis in the way that general medicine and surgery do. This inherent problem is very hard to resolve.

Throughout the seventies and eighties, the challenges that psychiatry was faced with were the exact opposite of those it has now. At the time, anthropology and psychology questioned the validity of psychiatry by saying that the change of someone going from normal to abnormal is on a gradual continuum, whereas psychiatry, due to its status as a medicinal science, and it’s concept of dealing with the disease, requires that a clear-cut judgment of whether there is an illness present or not be made. This inherent problem is hard to resolve. They also criticize the fact that the line separating normal from abnormal is completely manmade, lacking any biological basis whatsoever. Because of this, at that time, there were some anti-psychiatry campaigns, which believed that psychiatry was just a way for society to control things, labelling those actions that mainstream society deemed unacceptable as a disease.

Psychiatry, therefore, faced challenges from all walks of life, and at the same hadn’t really achieved a definite position in medicine, which caused it to react in a slightly paradoxical manner; because others criticized it for being too subjective, it decided to become arbitrary to the extreme. Psychiatry began anew, standardizing its diagnostic process in order to strictly define every disease, eventually giving shape to a set of standards, so that there would never again be room left for personal interpretation. In this way, stricter, more artificial classifications were created.

Does a standardised method take into account differences between patients?

This kind of mental illness diagnostic method frequently looks over the different backgrounds and causes of people and their illness, and groups everyone who exhibits the same symptoms together. Moreover, these subjective symptoms are often voiced by the patient itself, so the communication between the doctor and the patient needs to be based on the same semantic constructs in order to be successful. This means that diagnostic criteria need to be translated into a method that is common for the whole world, which requires mutual communication throughout the process.

The reason the number of people diagnosed with depression is increasing is actually because the language doctors and patients are using is moving closer to being identical. In reality, in the diagnosis of mental illness, it is often enough to simply follow certain indicators to reach a conclusion, doctors don’t conduct checkups which offer up anything to the patient about his mental and physical condition that he or she doesn’t already know; the patient can probably figure it out without even coming to the doctor. This is very different from our usual concept of disease, and depends on too many factors, and there are too many differences in opinion from different people included in its definition. The intrinsic structure of this logic is actually rather absurd, and can also cause problems to arise during diagnosis.

But amongst the many different kinds of mental illness, there are those that are hard to identify and those that are easy. Some serious conditions such as schizophrenia cause a big gap with normal affairs, those people cease any normal interaction or conversation with other people. Also, for these kinds of conditions, the use of medication is a very effective form of treatment, and can help us understand very clearly where the problem lay after all.

In contrast, less severe forms of mental illness, such as depression, often have a much more subtle and complicated background or origin. A lot of different illnesses can produce the symptoms common of depression. Using the standardized questioning method mentioned above, depression is commonly diagnosed, but, are all the diagnoses correct? Is there really a clear-cut way to determine what constitutes depression?

Diseases shape identity

Psychiatry has created many names for the illnesses it diagnoses. Before, people would say that these names were just a form of societal control, but, currently, there are many situations where people will actually accept these labels. The behaviour of some of these patients fits their diagnosis perfectly; their depression has even become a very important part of their identity.

Recently, in the psychiatric clinic, the amount of people with depression has been gradually increasing, and some of those people base some of their identity on the sentence “I am a depressive”. When they acknowledge this part of their identity as important, their identification as depressives will colour the way they view their own identity, their interactions with other people, and their roles within society. Some people with depression see it as an illness, and therefore consider that their moods should not be considered and cannot be dealt with in the same way as normal moods can, instead requiring professional help. They will require that they be treated as a special patient, and not as an ordinary person.

Achieving identity through illness is a very unusual phenomenon, and reflects the fact that the psychiatric vocabulary of the last 20 years has become more ingrained in Taiwanese society, and has become a part of some people’s identity, to the point where it has become a topic of discussion in everyday life. This is a process that has been given shape over a long period of time by many different factors. Some of the most important are the propagation by the media, the collapse of traditional social structure and institutions, and the increasing power of individualism, amongst others.

Irrationality in a rational system

How can we describe psychiatry’s role in society? Psychiatry is a space for irrationality within a rational system, which allows the mad individual to express their irrationality therein. This is not repression; it’s just a way of managing irrationality. As Michel Foucault wrote in “The History of Sexuality”, this really isn’t simply a power mechanism between the oppressor and the oppressed, but rather the mad part of you is dealt with by a relatively more tolerant rational mechanism.

There is a trend in our society in which only those who emphasize rationality and know how to suppress their emotional selves can be deemed normal and healthy. Over the last few years the words “mental health” have grown in popularity, but ultimately what is mental health? Mental health does not necessarily equate to happiness. In fact, there are two models for mental health. The first is the positive model, in which we pursue positive development, this kind of positive development can be reached through many different kinds of deep personal experiences; even short spells of depression can transform into positive energy, and lead to a more enriched and interesting mind. However, this aspect of mental health has little to do with treatment, and can probably be experienced in religious or social activities. The other model is the negative model, and is the way in which modern psychiatry treats irrational behaviour.

Function and position of psychiatric treatment

The welfare mechanisms in our society are very weak and offer very little support to the mentally ill; the resources dedicated to them are also limited. As a psychiatrist, it sometimes makes me feel utterly powerless. Because every patient a different story (maybe their husband died, or they got divorced, or became unemployed when they were middle-aged) at the root of their problems, even if I prescribe medicine for them, it does not guarantee that they will get better. If their personal environment and circumstances don’t change at all, it is not easy for their state of mind to take a turn for the better. Everybody has their own stories; some people are subjected to systematic domestic violence when they are growing up, or have many unbearable experiences, to the point where they can’t take it anymore and come to see a doctor. Only if the doctor can establish a long-term and deep psychotherapeutic connection, can he perhaps guide the person through growing up once more. If this connection cannot be established, in the brief period of time spent at the outpatient service, the help provided is often negligible.

Psychiatric treatment is one part of the societal mechanism for dealing with emotions. As psychiatrists, we come into contact with a lot of people’s emotions and innermost crazy conceptions, and these patients can only voice these in the presence of psychiatrists. Psychiatrists themselves are a part of the mechanism that manages and governs these irrational emotions. The knowledge that makes up this mechanism and its practical application may have some problems, but the problems it has have been balanced so far by the positive effects that it has brought about.

In today’s cinema, with its emphasis on entertainment and commercial success, it is no easy feat to find stories that take a risk by using people that are different as their main characters. It is much simpler to use explosions and CGI or make a sequel than to try to voice some form of social criticism. The two movies I am choosing to review this week try to do exactly that. Their central characters are special, and have limited capacity for interaction, but that does not mean that they are limited human beings.

Father Giuseppe Didone was born in a small town near Venice in Italy in 1940, he joined the Camillians at the age of 10, and was ordained in 1964. In 1965 he came to Taiwan, and later, in 1983 he founded a centre for intellectually challenged children, in 1987 he set up a similar centre in Yilan.

In this video he talks about his experience in Taiwan struggling to convince parents to overcome the stigma attached to mentally disabled children and get help for children in dire need of it, he also reflects on a shift in attitude from when he founded the school in the 1980s to the present day:

Reunion (1985)[1] plots the lives of a group of school chums at four points over 30 years. Starring Terry Hu (胡因夢) and Ding Nai-zhu (丁乃竺) - two Taiwanese actors who later transitioned into careers in the spiritual world - Reunion’s plot details the travails of the classmates over the years, reaching a climax when Ding's school for mentally handicapped children faces a crisis.

The first stanza begins in the mountains of rural Taiwan at an elementary school. Scenes of ragamuffins running amok in small town Taiwan are juxtaposed against the pastoral care of Ding, an attractive and kind young teacher who struggles to engender respect and responsibility in her students. The students, oblivious as the young so often are, only realize the extent of Ding's care for them when a dead-snake-in-the-drawer joke backfires. Ding has the bejusus scared out of her and the shame-faced students are resoundingly scolded.

Reconvening nearly ten years later, the second stanza unfolds during high school when the students reunite for a picnic. Ding has married a charming and creative young man and they are very much in love. The students reminisce, skylark and flirt at a riverside BBQ picnic. Then, just as this idyllic scene could get no more so, two rowboats on the lake capsize. Ding's husband gallantly dives in and rescues some students before he tragically drowns, bringing this segment to a grim close.

By the third stanza the students are now navigating the vicissitudes of life in martial law-era Taipei. Stock broker, lawyer, aspiring politician, doctor, chef and lorry driver, their lives have all taken different paths, something they discover upon reuniting for classmate and TV current affairs host Hu's wedding. Drunken melodrama and stifled emotions aside, this section is most notable for the group's reconnection with Ding. Now a widower and retired from teaching, Ding has taken to caring for mentally handicapped children in her house, something that shocks her former students.

Another ten years later and the gang are together yet again – this time banding together to help Ding. She has expanded her operation to help handicapped children, but with more children to care for come even greater problems. Landlords are unsympathetic and local groups protest the location of a “白癡中心 (idiot centre)” in the neighbourhood as it will ruin the ambience and negatively influence their own children. Against these exaggerated fears, the handicapped children are shown at work in the garden where they cooperate and learn at their own pace. Ultimately through the cooperation of the friends with Ding and the television special produced by Hu, the locals are shown to be accepting of the handicapped children.

The message

Reunion is notable for two features: the depiction of attitudes towards handicapped people and the beatification of Ding and Hu, something all the more remarkable given the direction that their careers took afterwards.

While the plight of the handicapped children cared for Ding is never far from the surface, the melodrama of Hu and her classmates tends to dominate the story. That said, the process of acceptance of the handicapped children, first by Ding’s former students and then by society, is interesting. The children are shown to be capable and loving, and while the story telling is at times overwrought, the humanity of these children is obvious. For that, the filmmakers deserve praise. Ding and Hu are able to engender emotional transformation of the humans around them, continuing the maturation process first evident in elementary school.

While Hu retired from the entertainment industry shortly after Reunion was filmed, Ding, husband of the noted Taiwanese-American playwright Stan Lai (賴聲川) remained more closely linked. In 1989 Ding hosted a TV show called 心靈之旅 (Journey of the Soul) and has become a proponent of Tibetan Buddhism, translating and promoting books by various lamas and hosting Tibetan Buddhist dignitaries when they passed through Taiwan.

Since leaving the entertainment industry in 1988, Hu has remained in the limelight through her roles as an anti-nuclear campaigner, author and translator of spiritual texts, and, recently, as a teacher of evolutionary astrology. Her books continue to be published in both China and Taiwan, where she is considered to be one of the key figures in the 'new age' spiritual scene[2]. While Hu acknowledges the utility of this term, it is not one that she is willing to label herself with. Rather, Hu considers her recent work to be psychological in nature. Regardless of how she classifies herself, Hu, along with Ding, is a notable and influential spiritual figure in contemporary Taiwan and her depiction in Reunion is just one phase of her spiritual development.

During the later parts of Reunion, Hu and Ding marshal their former classmates/pupils to help Ding’s centre for handicapped children. Through their combined efforts, the handicapped children find a better home and the students understand the strength of the friendship. Hu and Ding are integral in this process, and their stoical approach to the situation contrasts with the neuroses and agitation of those around them. Hu and Ding remain equanimous throughout, providing the example of how to transcend the mundanity of careerism and material success to benefit those less fortunate. Ding (a widow) and Hu (a divorcee) step beyond their marital status to provide a moral beacon for their classmates and students. They are inspiring to others, just as they are seemingly inspired by a deeper calling.

The idealized versions of Ding and Hu portrayed in Reunion are fascinating examples of if not life imitating art, then of art providing a template for future life choices. In the context of their current careers in Taiwan’s spiritual world, Hu and Ding might look back at the film with a smile. The everyday spirituality embodied in Reunion proved to be not dissimilar to the images projected throughout their later career choices.

Dr. Guo: I'm a resident doctor in the (confidential) hospital. I'm in the third year of my training. My specialty is psychiatry.

Julia: Today we're going to talk about the illegal drug MDMA from a psychiatric point of view. Some people call this pill MDMA; others call it ecstasy. Can you tell us the difference between these two names?

Dr. Guo: MDMA is the abbreviation of the chemical name, 3,4-methylenedioxy-N-methylamphetamine. Ecstasy is its street name. The earliest psychiatrists who used MDMA in psychotherapy nicknamed it "Adam" because it gives the user the feeling of returning to Eden... The name "ecstasy" took on later because it sounded more exciting. "X" and "E" became its abbreviation. In Taiwan it's called "Yi" (衣) (pronunciation similar to "clothes" in Chinese.)

Julia: According to my knowledge, this substance temporary transports you to an altered state of consciousness. Can you describe this condition?

Dr. Guo: In a normal situation, you usually perceive sound, light or touch as separate sensory elements. However, after taking E, one is transported into a state of "totality." Your senses are enhanced: auditory, visual, tactile; but the result of enhancement is a state of wholeness. Under that condition, you only sense things in their entirety; you are not able to separate one sensory element from another.

This is built on the premise that you are taking this substance alone, but if you are with another person, the effect is totally different. When you are with somebody, you might find that the boundaries and distance between you and that person begin to soften. But that's only an impression. If you actually take action and participate in conversation, you'd find your interaction to be surprisingly smooth. Communications often turn into brainstorms. Under that situation you can communicate your ideas more freely, and other's responses or questions will in turn inspire new ideas.

But although you might feel that such experiences enable you to let down your guard and soften your boundaries, after the effect declines, the boundaries will still be there, even if you are willing to tear them down.

Julia: But at least you are aware of such a possibility in human relationships.

Dr. Guo: Perhaps its potency is that it makes you become aware of the rigid boundaries you set for yourself, yet I believe to actually dissolve these boundaries, it requires some extra effort.

Julia: Okay, so from a medical perspective, why does MDMA let people attain such a status?

Dr. Guo: That's because MDMA causes the brain to release large amounts of serotonin. When the secretion of serotonin reaches a certain level, it causes serotonin syndrome, which is also a common side effect of anti-depressants. It causes physical tremors and hyperactivity. MDMA stimulates your motor nerves, which coincidentally makes it a great match with the rhythmic beats of electronic dance music. You may feel that your physical movements are in sync with the rhythm. That's why it's so popular in the dance music scene. It's related to the resonance that the sound creates in your body. Metaphorically speaking, you are vibrating on the same frequency with others, which leads us back to the de-territorialization we mentioned before: your body and soul become one with others.

Julia: Is that also why some people experience e-blues or "coming down" – the emotional state of depression that follows the decline of the effect – is that also caused by serotonin?

Dr. Guo: Yes, it's because of the exhaustion of serotonin.

Julia: I see. So it seems like MDMA is in many ways similar to standard psychiatric medicine. So why do you think MDMA is illegal?

Dr Guo: Politics.

Julia: You mean it's entirely due to politics? There's nothing to do with the substance itself?

Dr. Guo: Actually many researches currently reveal how like marijuana, the harmful effects of MDMA on the body are actually less than legal cigarettes and alcohol. So how come cigarettes and alcohol are legal while others are not? This points to other influences...

But when you speak of substances like heroin, sure it can lead to dependence, and can create a lot of damage too – some illegal substances do have that kind of potential. But on the other hand, if you speak of legal medicine such as Stilnox (a kind of sleeping pill) and Xanax (an anti-anxiety medicine), sure they are legal, but they can also easily lead to dependency and can cause damage to the human body. So I think the boundary tends to become a little bit hazy.

To determine whether a drug should be legal or not, whether it is harmful or not, is actually not that simple. It really depends. In my opinion, we should observe how this substance is used and how it affects the user's behavior and attitude.

For example, some people are more prone to anxiety and they need Xanax to relax, so they habitually take Xanax whenever they're anxious. But when they use MDMA, they may avoid using it on workdays and only use it on holidays in order to function properly. They can control these things, but they must take Xanax whenever they have anxiety, so in this sense they are even more addicted to Xanax.

Julia: Because ecstasy can often makes one exhausted after its effects cease. Xanax has less side effects, so one can choose to take Xanax daily but not Ecstasy.

Dr. Guo: True, but if you take Xanax everyday, it's still going to damage your memory. So in a sense Xanax is doing more harm to this person than Ecstasy, since Ecstasy is taken only every once in a while, while Xanax is taken everyday. In this sense, a legal drug like Xanax can do much more harm than an illegal drug like Ecstasy. So I really think it's a matter of degrees, there's no clear-cut distinction to this. Nothing's all good and nothing's all bad. A substance can lead to positive results on one person while causing harm on another. Nothing is absolute.

Julia: But don't you think a part of the legal determination is the degree of the high – the higher a drug gets you the more easily it gets banned?

Dr. Guo: But a lot of people get high on alcohol.

Julia: So you don't believe in such a distinction?

Dr. Guo: Perhaps we can look back to the context under which MDMA was banned. Around the beginning of the eighties, American psychotherapy societies were secretive about their use of MDMA in medical practice, but around 1984, MDMA began to circulate widely in America's recreational drug market. The press started honing in and Reagan's conservative Republican government took rigid actions, banning every type of drug that was used for medical purposes. Even though not much was known about the safety and medical benefits of the drug, the Drug Enforcement Administration (DEA) still decided to list MDMA as a Schedule I drug in 1985. Schedule I means that this substance is highly addictive, has no accepted medical use in treatment and is not safe to use even under medical supervision. That is to say, this drug does only harm and no good.

Of course, after a drug is placed in Schedule I, research on it becomes extremely difficult. According to knowledge accumulated through years of experience, the psychotherapy societies who practiced therapy with MDMA believed that it had high medical potential while causing less harm to the human body than most people think. They felt that it shouldn't be placed in Schedule I and called for a hearing, hoping that their reports upon the benefits could lower the level of control upon MDMA. After the hearing, the judge and juries all advised the DEA to lower MDMA to Schedule III in order to leave more space for the assessment of MDMA's medical properties. However, the DEA did not accept their advice and kept MDMA in Schedule I.

It wasn't until after years of research that the relative harmlessness of MDMA was proven and that clinical trials upon its medical benefits became possible. If MDMA was not placed under Schedule I in the first place, perhaps we could've assessed its safety and medical benefits much sooner. So I think this issue is actually highly related to politics and ideology.

Julia: But it must take a very long time to prove such a substance harmless or otherwise. Take the newly synthesized "legal high" drug bath salt for example; it was already circulating in the market before any assessment could be made, and it soon made its appearance in headlines as a dangerous drug that turns people into face-eaters. Perhaps it would be more cautious to set it as illegal before any more damage is done?

Dr. Guo: Well I guess this is a question of ideology; it depends on the attitude you take towards the situation. You can argue to ban this substance before any assessment is made, that's one point of view. The other stance would be to make sure that a substance is truly harmful before any legal actions are made. Of course there are also others who believe that whether one uses or abuses a substance or not is strictly a personal matter and the option of banning shouldn't even be considered.

A lot of this is a matter of balance. When you're using the law to inhibit something, that influence is enormous. Everyone must act according to this rule. So it is actually a pretty big deal that affects everyone, no matter whether they think of using it or not. The influence is full-scale.

Julia: So how does science decide whether a drug is harmful to a person or not?

Dr. Guo: They do experiments on animals. Usually before a drug is legally approved to be marketable, they must first determine whether this substance is harmful – that it is not harmful within a certain range. Only after the drug passes this step can scientists begin research upon its medical properties. It must be done this way. If it is proven to be harmful, there won't be any next step to test its practicality. For these tests of harmfulness we usually use experimental animals. There are already some animal modules for scientific research, that is if I want to test a specific drug, I first use it on rats and see what dosage causes what percent of rats to die, and from this dosage they get to calculate the equivalent dosage that may cause damage to the human body. Any drug that wants to apply for legal marketing must go through this process.

Julia: Did the research on MDMA go through such a process?

Guo: No. Because there wasn't enough data for such a process to even happen. They just went and banned it. The people who were against classifying MDMA as Schedule I possessed some research data; there wasn't much research upon the medical beneficiary of the drug, but there were some assessments upon the drug's harmfulness. That's also probably why the aforementioned judge felt that MDMA shouldn't be placed in Schedule I. Maybe he took a look at the data and didn't find any strong evidence that pointed towards definite harmfulness. So the judge advised the DEA to place it in Schedule III so that it could be researched for its medical use.

When they placed it as Schedule I, the report showed that their animal experiments involved direct injection of large quantities of MDMA intorats' brains to prove that MDMA is harmful to the nerves of their brains. Yet some researchers object to this by pointing out that normally one does not inject MDMA; it is orally consumed and passes through through the liver. So the quantity actually consumed is definitely way less than the amount they injected in the rats' brains. That's way too much and it will definitely harm you. But these scientists just turned in this report and say "see? It's proven to be harmful," but actually it's really a matter of degree.

In other words, the legal process in which they classified this drug as Schedule I cannot be described as solid and exact. It hasn't been thoroughly scrutinized and analyzed. They just "wham" and banned it just like that, because it was the era of the War on Drugs. Speaking of which, it was Reagan's wife who chaired the "Just Say No" drug awareness campaign. So it was actually a heavily ideologicallyinfluenced decision.

Julia : So do you think medical psychiatry's attitude towards drugs is still influenced by the law? Are they willing to use illegal substancefor medical use now?

Dr. Guo: Well to talk about it, you must refer to the current research on MDMA. Actually in the mid seventies, doctors were using this substance for medical purposes. It's related to the feature of this drug – MDMA can create a strong sense of empathy – that's one feature. The other is that it lowers the defense mechanism of the user. The empathy effect is often applied in marriage counseling, in couples' therapy.

Julia: But doesn't that make you blurt out all the things that should be kept under the carpet? Perhaps after the effect recedes, one would hold grudge against another...

Dr. Guo: But that's the way to really solve problems, relationship is a mutual issue. Perhaps in the past you've done some wrong things, but you couldn't admit the damage you've done to other people. By taking this drug, you become more willing to listen to the other person and understand the consequences of your actions. That sort of empathy creates a chance to reflect upon one self. That's what improves your relationship.

So that's how MDMA's empathy-enhancing feature can be used in therapy. Its ability to lower self-defense, on the other hand, is practical in treating patients suffering from post-traumatic stress disorder (PTSD). The psychical defense mechanism of those who suffer from PTSD are activate in order to separate the consciousness from traumatic experiences or emotions, so that the subject will not have to face the painful emotions brought on by this trauma. However, the dissociative disorder that accompanies such a repression can destabilize the mental faculties, so that the PTSD patient still continues to suffer from his/her trauma, only in another way.

While one finds it difficult or impossible to articulate his/her own trauma in his/her current mental state, perhaps under the effect of MDMA and the guidance of another person, one could turn this trauma into words. It is only after your defense is lowered that talking about such things becomes possible, which enables you to face the impact of this trauma.

It is under these circumstances that they found out about the features of this drug and how it could be used in therapy. It has been proven to be helpful in the process of working-through, so basically a lot of people were using it. However, they knew that a lot of clubs were using it too, and under the social atmosphere at that time, it could easily be banned under political influences. So they were pretty secretive about this stuff. Due to the secretiveness, they couldn't clinically prove the medical benefits of this drug, so when it was going to get banned, they couldn't prove that it was actually beneficial.

So after the execution of this law, there was even less chance of studying this drug, but gradually they were able to prove that MDMA is less harmful than anyone imagined. So with these evidences they kept on designing rigorous research methods and applying for clinical trial and finally they've attained permission. So far research upon the benefits of MDMA in treating PTSD patients has been done in the United States and Switzerland. They recruited a couple of PTSD patients whose symptoms did not improve after taking anti-depressants such as Zoloft, and gave them small dosages of MDMA while going through psychotherapy.

They divided these people into two groups, one who has taken MDMA and one who hasn't. By the way, the experiment was double-blind, meaning that neither the researcher nor the researched subject knows who has taken MDMA or placebo. This is the most meticulous research method; that way there can be no placebo-effect to mess up the results. The results showed that patients who took MDMA during psychotherapy had an obvious improvement in terms of their symptoms compared to those who didn't. The American research has been completed and is already published in journals. The Swiss research, also completed and published, supports this conclusion to a certain degree. These conclusions are proven through the strictest standardized clinical trials.

Julia: To treat a patient with anti-depressant is to let him take the medication and wait for its effects, but I assume that the treatment with MDMA works differently?

Dr. Guo: Yes. MDMA is used during psychotherapy sessions. It isn't like treatment with anti-depressant, where you just prescribe the pills and wait for its effect. It is used as an adjuvant, as an assistant drug during psychotherapy. So you can say that psychotherapy plays the main role whereas MDMA is its assistant. It catalyzes the interaction and the process of working-through during therapy.

Julia: So is there any study on the relapse condition?

Dr. Guo: Well, nothing has been published yet. The American research has done a follow up study, which has already been accepted by journals, but is still waiting for publication. What they claim is that the follow up results upon these cases (usually a follow up research lasts for three years) shows that after three years, their improvement still continued to sustain. So this research has a statistical significance. It doesn't just last during the sessions.

Julia: I see. So aside from this, are there any other examples thatuse illegal substances for medical research?

Dr. Guo: In the 80's, an organization called MAPS (multidisciplinary association for psychedelic studies) was established. It is a non-profit organization – their research-funding comes entirely from donations. Aside from research on the combination of MDMA and psychotherapy for treatment on PTSD patients, they've also done research with marijuana and LSD. They use rigorous scientific methods to do experiments with illegal substances.

Let me see, there is currently research on using LSD to lessen the pain of patients with terminal cancer. They try to be as scientific as possible in hopes to prove that substances that are deemed as illegal can actually help mankind. They don't deny that these substances may cause damage, but they want to observe under structural, normalized conditions of treatment whether these substances are really as bad as they seem.

Julia: I see. Do you have anything else you want to communicate withthe readers?

Dr. Guo: The discussion on MDMA in Taiwan is often centered upon its negative features, whether from the

Dr. Guo Jia-ying (郭家穎)

light of social commentary, law enforcement or ethical debate. We don't need to talk about that here, the media is always reporting on it. But sources that support MDMA are scarce. In literature we've only go the Chinese edition of Altered State: The Story of Ecstasy Culture and Acid House and Waiting for the Man: The Story of Drugs and Popular Music; as to pro-drug discourse, I know that Pots Weekly had some pro-drug columns that discussed the problem from the view of politics, sociology and substance abuse. There are also some academic papers on this issue, but there are extremely few discussions of this problem on a medical point of view.

According to my knowledge, there was a forum upon this issue following the publication of the Chinese edition of Altered States, probably in 2003. I believe Lung Ying-Tai (龍應台) was also there? She was still head of the Department of Cultural Affairs then. Wang Hao-wei (王浩威) was also there, he's a psychiatrist who is currently promoting psychotherapy and has published several psychotherapy books. There also another forum that invited a psychiatrist, but his opinions upon this issue were also general and reductive. These are the only two events on the internet that involved psychiatric professionals. So in Taiwan's medical field, there really hasn't been much public discussions upon this issue. I hope perhaps this time I can provide some new progress upon the medical knowledge of MDMA in the psychiatric field.

One of the best things that ever happened to me was getting polio. Not because polio was a pleasant experience, but because due to polio my life took a new direction which has brought me many blessings I might otherwise have never had.

We all have disabilities we have to live with. Since they won’t go away, then we just have to do the best we can to live with them in such a way they don’t prevent us from having a good time.

One of the worst things that prevents us from having a good time is wishing things were better or easier than they are now or feeling sorry we aren’t doing something else. Some people go through life so regretful of what they can no longer do, they have no energy left to enjoy the things they still can do.

Everyone wants to spend happy meaningful lives. The trouble is we try to imitate the lives of others we envy rather than develop our own. We pine for the grass on the other side of the fence instead of watering the grass under our own feet. We feel so sorry we don’t have the whole pie, we fail to enjoy the piece we have. We sit patiently waiting in vain for our ship to come in, instead of going out to find it.

Not all of us have the good fortune of being born with silver spoons in our mouths, a symbol of health and prosperity and success. But there is not a one of us whose iron spoon cannot be silver-plated.

Have you ever seen a diamond in the rough? Once many years ago, a man went into the desert to collect rocks he could sell to tourists. One day he found a big dirty rock. It was ugly, but looked so unusual he picked it up anyway. He was very pleased when a man who came into his shop purchased it right away for ten dollars. That ugly stone turned out to be a big raw diamond, which when cleaned and polished was worth about half a million dollars.

Look at yourself in the mirror. What do you see? Only a broken down person with disabilities and limitations? If that is all you see, then you are blind or misled by appearances. If you see someone sad, it is because you look sad and that makes you sadder. You better look away. If you see someone relatively happy and content, it is because you look that way and that makes you feel even better. We need to train ourselves to see the diamonds that are in us.

When you look at yourself in a mirror, don’t see only your flaws or your limitations or disabilities. You are a person who has flaws, but you are not the flaws. Think of yourself as a diamond in disguise.

A diamond covered with dirt does not shine. A diamond in the dark does not sparkle. An uncut diamond is a worthless rock to the untrained eye, but it is still a diamond. The measure of the value of a package is its contents not the wrappings. Train yourself to see the diamond in you. If others don’t see it, it’s their misfortune.

Always listen to what others have to say and take advantage of their advice when it helps, but don’t let yourself get upset when they say something that doesn’t ring true. It is their mistake not yours.

Don’t look so hard at what you admire in others that you fail to see what there is to admire in your self.

I have some friends who don’t like themselves. They wish they were someone else. They wish they were somewhere else. They wish they were stronger or had more brains or more money or more success. They are so anxious about what they wish they had, they have no energy left to do anything worthwhile with what they still have.

One of the happiest persons I know is mentally retarded. There is very little that he can do, but he knows how to enjoy each moment without envy or regret. Since he grew up in a family that loves and respects him, he respects himself. He is at peace with himself.

The unhappiest person I know is also mentally retarded. She despises herself because she grew up in a family that was ashamed of her and rejected her for being defective. To be unhappy with her self is all she ever learned. She is not at peace with herself.

So, what kind of a person are you?

Some people are always thinking of what might go wrong. “I don’t know what the future holds for me. I’m afraid. I’m hurting and it might get worse. I’m declining and don’t know when it is going to stop. I have to depend on others to do for me things others can do for themselves. Oh woe is me!!”

Some people concentrate on what is still right. “Look, I’m still here. I hurt, but it could be worse. There are still things I can do. I have someone to help me do what I can’t do by myself. How lucky I am!!”

Sometimes our lives get blown off course. We discover a bridge blown down or a barrier across the road, or we run up against a stone wall. We can either knock it down, crash into it, tunnel through it, detour around it, stop and wait for it to disappear, or turn around and go somewhere else.

When a sailor is knocked off course, he either has to adjust the rudder to get back on course or set another course.

I only have one life. The experiences I will have today are the only ones I will have. So I must do my best to make these experiences worth while and to enjoy as best I can whatever happens. It may not be the experience I wanted, but it’s my experience. I either find some way to live with it, get some good out of it or my life is hell.

There is peace in knowing my hand is still on the rudder. I may be passively being tossed about, but I still have a hand in determining how I react. I refuse to surrender to the winds or the waves of life like a dead piece of driftwood or drifting cloud.

Once when I was small I looked up at the sky and noticed the first whiffs of a new cloud appearing on the horizon. “Look, Mommy,” I said, “there’s a cloud being born.” How exciting it was to watch it change size and shape right there before my very eyes.

I thought it was a miracle, but in reality, of course, it was just a giant glob of vapor adrift at the mercy of wind currents, air pressure, and temperature. It may have looked peaceful, but it didn’t feel any peace, because it didn’t know or feel anything.

Sometimes we feel tempted to just sit back and surrender like clouds when our lives are blown about by events that throw us off course. But that would be a mistake because we aren’t clouds. We are much more like ships at sea tossed about by winds, waves, and currents, because like ships, we have rudders and motor power. We can react to the winds and the waves. We can resist the pressures or adjust to them. We can accept or reject the opportunities and changes we encounter in life.

Unfortunately, being the captains of our ships doesn’t make us captains of the waves. Standing at the helm doesn’t prevent storms, but every time we turn the wheel, shift sails, or change speed, we alter our ship’s course. These tiny changes may be insignificant by themselves, but they will always manage by the storm’s end to have positioned and oriented our ships differently from where they would have been had we done nothing.

We are not just passive playthings in the hands of fate. When we finally enter harbor at the end of a storm, we have had a hand in reaching it. For better or for worse, our decisions and efforts determine the course of our lives more than the fortuitous or calamitous events.

Eventually some time in the future I will go down with my ship when the winds and waves of life finally overwhelm it. But I will go down peacefully and proudly knowing that I kept my hand on the helm as long as I could. The best way to die is to keep on living as well as you can.